| Entity Name: | KEILER HEBERTO MORENO RIVERO, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 26 Jun 2017 (8 years ago) |
| Document Number: | P17000055185 |
| FEI/EIN Number | 82-1991660 |
| Address: | 2940 Mallory Circle, CELEBRATION, FL, 34747, US |
| Mail Address: | 2940 Mallory Circle, CELEBRATION, FL, 34747, US |
| ZIP code: | 34747 |
| County: | Osceola |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1861974073 | 2018-09-04 | 2022-05-31 | 1251 EMERSON PARK BLVD APT 105, CELEBRATION, FL, 347475371, US | 2940 MALLORY CIR STE 202, CELEBRATION, FL, 347471818, US | |||||||||||||||||||||
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| Phone | +1 407-269-8550 |
| Fax | 4072881010 |
Authorized person
| Name | DR. KEILER MORENO RIVERO |
| Role | OWNER |
| Phone | 4072698550 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 018667500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MORENO RIVERO KEILER H | Agent | 2940 Mallory Circle, CELEBRATION, FL, 34747 |
| Name | Role | Address |
|---|---|---|
| MORENO RIVERO KEILER H | Director | 2940 Mallory Circle, CELEBRATION, FL, 34747 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000019138 | MORENO'S INTERNAL MEDICINE | ACTIVE | 2022-01-21 | 2027-12-31 | No data | 2940 MALLORY CIRCLE, STE. 202, CELEBRATION, FL, 34747 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-01-28 | 2940 Mallory Circle, Suite 202, CELEBRATION, FL 34747 | No data |
| CHANGE OF MAILING ADDRESS | 2021-01-28 | 2940 Mallory Circle, Suite 202, CELEBRATION, FL 34747 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-01-28 | 2940 Mallory Circle, Suite 202, CELEBRATION, FL 34747 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-16 |
| ANNUAL REPORT | 2023-04-26 |
| ANNUAL REPORT | 2022-02-04 |
| ANNUAL REPORT | 2021-01-28 |
| ANNUAL REPORT | 2020-02-19 |
| ANNUAL REPORT | 2019-02-18 |
| ANNUAL REPORT | 2018-02-13 |
| Domestic Profit | 2017-06-26 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
